Suit faults hospital over agency nurses

Part-timer blamed in death

A patient's death after falling from his bed in a Plantation emergency room has raised questions about a common practice of hospitals hiring outside, fill-in nurses on a regular basis.

Critics of the practice, including nurses' groups and some industry officials, say medical care for patients may suffer when hospitals rely too heavily on short-term, temporary nurses who may not know a facility's system, patients, personnel or building as well as staff nurses.

Even hospital officials said they prefer not to use fill-in "agency nurses" from staffing firms because of a potential for lapses in quality. But with a lingering nurse shortage in Florida and most of the nation, the use is not likely to drop soon.

An estimated one in eight registered nurses in Florida hospitals were agency fill-ins, a survey found last year.

"We don't like to use agency [nurses] because it's very expensive labor and . . . if you bring people from out of your organization, it's not optimal," said Martha DeCastro, vice president of nursing for the Florida Hospital Association. "But it's better than not having the staff at all."

An issue that has persisted for decades in the industry has flared up after the death of retired plumber William T. Fain, 80, while in the care of an agency nurse at Westside Regional Medical Center.

Fain came to the ER after a seizure on Super Bowl Sunday in 2006, his family said in a negligence suit filed last month. Doctors ordered nurses to send Fain to intensive care and, in the interim, take steps to prevent him from falling from his bed, the suit said. They were to put up bedrails, lower the bed and check him more often.

The agency nurse on his case did none of those steps, the suit said. After he spent 12 hours in the ER, and shortly after his family left for the evening, nurses found Fain on the floor. He fell, hit his head, suffered brain damage and died two weeks later, an autopsy report said.

"We would have never left if we knew he was not going to the ICU," said his daughter, Rebecca Fain. "He gave me a hug and a kiss and said, 'See you tomorrow.' [The next morning], he was mentally gone. He never knew me again, never knew my mom again."

That the hospital used agency nurses who did not know or follow procedures was a big part of the problem, said David Durkee, the family attorney. Westside Regional declined to comment, except to say in a statement that agency nurses are common and officials are "confident in the quality of care provided by nurses at our hospital."

The staffing agency, Nightingale Nurses, referred calls to manager Michael List. Several attempts to contact him and the company's attorney, Michael Brand, were unsuccessful. In court papers, the company denied any negligence in Fain's death.

The use of agency nurses has climbed as aging nurses and other factors have fueled today's shortage, industry experts said. Two hospital surveys last year found that about 10 percent of RN positions were vacant, including a state high of 16 percent in Broward and Palm Beach counties combined.

Those figures are underestimates because many hospitals wish they could hire more nurses than the positions they have, said Mary Lou Brunell, director of the state-sponsored Florida Center for Nursing. The practice is even more common in home health service (56 percent) and hospice (23 percent).

Hospitals reported that agency nurses filled 12 percent of RN jobs. Their use and the nursing shortage are not declining, Brunell said. In 10 years, Florida could lose 40 percent of nurses to retirement and attrition.

In a rare consensus, unions and hospital officials have agreed that agency nurses fill a need in health care. Some nurses favor agency work for the flexible schedules and the pay - wages can top that of staffers - while hospitals rely on temporary help during South Florida's tourist season and other unusual rushes.

Agency nurses do best when they get an orientation in advance or work in one place for long periods, union and hospital officials said. But that doesn't always happen. A fill-in may work at a dozen hospitals in a month, said Monica Russo, president of Service Employees International Union Florida Healthcare in Miami, which represents nurses and aides.

"The regular nurse who comes in every day can spot a condition with a patient, spot a development more easily than a person coming in cold," Russo said. "It's not a question of skill or quality; it's a question of familiarity with your team, who your nurses are, who your administrators are, who to call on in an emergency."

"The only problem with agency nurses is if they become too much of your staff," said Betsy Marville, an RN at St. Mary's Medical Center in West Palm Beach. "There's not the continuity."

Little research has been done comparing agency nurses and staff nurses on quality and errors. A small study from Paris found more patient infections among patients treated by agency nurses than by staffers.